| NPI | 1609150069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 7647) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: RI MHC00512) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |